title: [Flow dynamics analysis in patients with a ruptured middle cerebral artery aneurysm. A case report].
abstract: Despite advancement of diagnostic and treatment modalities, subarachnoid hemorrhage (SAH) is still an entity of neurosurgical emergency with poor outcome. Recent reports indicated that hemodynamic stress might play an important role in rupture or the growth of cerebral aneurysms, but there is no consensus about how or which hemodynamic factor contribute to this phenomenon. In this report, magnetic resonance (MR)-based flow dynamics analysis was performed for a patient with SAH and the data obtained were directly compared with intraoperative findings. This 74-year-old woman was admitted for sudden onset headache. Head computed tomography scan showed SAH on the right sylvian fissure and intracerebral hematoma on the right temporal tip. Digital subtraction angiography showed a right middle cerebral artery aneurysm, which was considered to be the ruptured one. The aneurysm had two blebs, and the bleb around the aneurysm tip was exposed to low magnitude and high oscillation of wall shear stress (WSS). On the other hand, another bleb was exposed to high magnitude and low oscillation of WSS. Next day, the patient underwent open surgery and intraoperative findings showed the aneurysm tip was the ruptured point. MR-based flow dynamics analysis might be a useful diagnostic modality for patients with SAH. Although low magnitude and high oscillation of WSS might contribute to the aneurysm rupture, further case accumulation is necessary to reach a conclusion whether or not this is so.
authors.affiliation: Departments of Neurosurgery, Aomori Prefectural Central Hospital, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanamori
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takazawa
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Omodaka
authors.forename: Shingo
authors.initials: S
authors.lastname: Yonezawa
authors.forename: Noriko
authors.initials: N
authors.lastname: Maeda
authors.forename: Kenya
authors.initials: K
authors.lastname: Sato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Midorikawa
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sasaki
authors.forename: Michiharu
authors.initials: M
authors.lastname: Nishijima
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000503:physiopathology* / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D013345:Subarachnoid Hemorrhage / Q000209:etiology; D014057:Tomography, X-Ray Computed